Global Prevalence of Sleep-Disordered Breathing in Intracerebral Hemorrhage Survivors: A Meta-Analysis and Systematic Review

Background: Sleep-disordered breathing (SDB) and intracerebral hemorrhage (ICH) share a bidirectional relationship: SDB may increase ICH risk, while ICH can induce or exacerbate SDB. However, the prevalence and characteristics of post-ICH SDB remain poorly defined. Objective: To estimate the prevalence of SDB among ICH survivors and examine associated clinical factors, including the relative burden of obstructive (OSA) versus central sleep apnea (CSA). Methods: A systematic review and meta-analysis were performed across PubMed, Scopus, CINAHL, and ClinicalTrials.gov. Studies assessing SDB in adults with ICH using American Academy of Sleep Medicine (AASM) category 1–4 diagnostic devices were included. Random-effects models estimated pooled prevalence at varying apnea–hypopnea index (AHI) thresholds, with subgroup analyses by setting, timing, geography, and diagnostic factors. Results: Seventeen studies met inclusion criteria. Pooled SDB prevalence was 85% (95% CI: 80–91%) at AHI > 5, with 49% (95% CI: 42–57%) experiencing moderate SDB (AHI > 15), and 21% (95% CI: 15–27%) experiencing severe SDB (AHI > 30). The prevalence of OSA predominated 73% (95% CI: 64% to 82%),while CSA occurred in 5% (95% CI: 2–9%), corresponding to a pooled RR of 7.44 and OR of 53.08 for OSA versus CSA. Conclusions: SDB—primarily OSA—is highly prevalent following ICH, underscoring the need for early, routine screening and intervention to improve neurological and cardiovascular outcomes.